- 作者：Macarena Sim贸n-Talero ; Rita Garc铆a-Mart铆nez ; Maria Torrens ; Salvador Augustin ; Susana G贸mez ; Gustavo Pereira ; M贸nica Guevara ; Pere Gin茅s ; Germ谩n Soriano ; Eva Rom谩n ; Jordi S谩nchez-Delgado ; Roser Ferrer ; Juan C. Nieto ; Pilar Suny茅 ; Inma Fuentes ; Rafael Esteban ; Juan C贸rdoba
- 关键词：HE ; hepatic encephalopathy ; ACLF ; acute-on-chronic liver failure ; ALB ; albumin group ; SAL ; saline group ; CHESS ; clinical hepatic encephalopathy staging scale ; HESA ; hepatic encephalopathy scoring algorithm ; TNF-伪 ; tumor necrosis factor alpha ; IL ; interleukin ; MDA ; malondialdehyde ; MELD ; Model for End-Stage Liver Disease
- 刊名：Journal of Hepatology
- 出版年：December, 2013
- 年：2013
- 卷：59
- 期：6
- 页码：1184-1192
- 全文大小：1913 K
Background & Aims
Episodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial ( number, ).Methods
Cirrhotic patients with an acute episode of hepatic encephalopathy (grade II-IV) were randomized to receive albumin (1.5 g/kg on day 1 and 1.0 g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200 mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters.
Results
Fifty-six patients were randomly assigned to albumin (n = 26) or saline (n = 30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p >0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p = 0.02).
Conclusions
Albumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin.